Treated diastolic blood pressure: how low is too low?

Lowering diastolic blood pressure (DBP) to under 60 mm Hg is associated with increased risk for adverse cardiovascular (CV) events, according to a JAMA Network Open study. Current U.S. guidelines recommend a blood pressure target of under 130/80 mm Hg but do not specify a lower DBP limit.

Researchers conducted an analysis of data from some 7,500 adult participants of recent blood pressure intervention trials (SPRINT and ACCORD-BP) who achieved a treated systolic blood pressure (SBP) 130 mm Hg.

Patients treated to a DBP level (60 mm Hg had significantly increased risks for the primary outcome (all-cause death, nonfatal myocardial infarction (MI), and nonfatal stroke; hazard ratio, 1.46), a composite cardiovascular outcome (CV death, nonfatal MI, and nonfatal stroke; HR, 1.74), nonfatal MI (1.73), and nonfatal stroke (2.67), compared with those with a DBP of 70 to (80. A treated DBP of 70 to (80 was associated with the lowest risks. Results were similar in analyses adjusting for systolic blood pressure.

The authors suggest that findings "only serve as a caution regarding lowering DBP to less than 60 mm Hg and as an important hypothesis to be tested in future prospective studies regarding safe and optimal DBP ranges."